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Part of this study was presented as a poster on the 64th Annual Meeting of the American Academy of
Dermatology, 37 March 2006 in San Francisco, CA, USA.
Synopsis
It is generally stated that drinking plenty of water
has a positive influence on skin condition. However, there is no published scientific study that has
investigated this matter. The aim of our exploratory before-after study was to evaluate the in vivo
influence of drinking more than 2 L of mineral
water or ordinary tap water per day on skin physiology. Ninety-three healthy subjects were included
in our prospective study. After an initial run-in
phase of 2 weeks to monitor individual drinking
habits, subjects had to drink 2.25 L day)1 of either
mineral water (n 53) or tap water (n 40) for
4 weeks. Bioengineering in vivo measurements on
the volar forearm included sonographic evaluation
of skin thickness and density, determination of
skin surface pH, assessment of skin surface morphology, and measurement of finger circumference. Eighty-six subjects completed the study. In
the mineral water group measurements revealed a
statistically significant decrease in skin density.
Skin thickness increased slightly, albeit not at a
statistically significant level. However, when separately analysing those individuals from the mineral
Correspondence: Professor Martina Kerscher, MD,
Division of Cosmetic Sciences (FB 13), University of
Hamburg, Martin-Luther-King Platz 6, D-20146
Hamburg, Germany. Tel.: +49 40 42838 7235;
Fax: +49 40 42838 2592;
e-mail: martina.kerscher@uni-hamburg.de
water group, who had routinely drunken comparably little before the start of the study, their skin
thickness increased at a statistically significant
level. Skin surface pH remained almost unchanged
in the physiologically optimal range. In the tap
water group, skin density increased significantly,
while skin thickness decreased significantly. Skin
surface pH decreased at a statistically significant
level. While in the mineral water group finger circumference decreased significantly, measurements
in the tap water group revealed a statistically significant increase. Objective skin surface morphology did not change in any group. In summary,
drinking more than 2 L of water per day can have
a significant impact on skin physiology. The exact
effects within the skin seem to differ depending on
the nature of the water ingested. Randomized,
controlled, double-blind follow-up trials are warranted to confirm the findings of our exploratory
pilot study.
Resume
Il est generalement etabli que boire abondamment
de leau influence letat de la peau. Cependant,
aucune etude scientifique publiee ne traite de ce
sujet. Le but de notre etude exploratoire avant/
apre`s a ete devaluer in vivo linfluence de
labsorption de plus de 2 litres par jour deau
minerale ou du robinet sur la physiologie de le
peau. 93 sujets en bonne sante ont participe a`
131
S. Williams et al.
Introduction
Depending on age, gender and body mass index,
approximately 4570% of our body weight consists of water with one-third of the total body
water being extracellular and two-thirds within
the intracellular compartment [1]. The movement
of water across cell membranes, which are freely
permeable to water, maintains the osmotic equilib-
132
S. Williams et al.
560
92.5
56.6
1812
4500
8
42
2
130
1
0.03
10
12
0.6
0.09
133
S. Williams et al.
and after the 4-week drinking period was performed descriptively through means of two-tailed
statistical tests (nonparametric Wilcoxon test
for paired samples). P 0.05 was considered
statistically significant (marked with * asterisk in
diagrams), P 0.001 was considered statistically highly significant (marked with *** in diagrams).
Results
Eighty-six subjects completed the study; 50 subjects in the mineral water group (36 female, 14
male; mean SD: 31.8 8.9 years) and 36 subjects in the tap water group (26 female, 10 male;
mean SD: 31.8 8.7 years). Seven of the recruited 93 volunteers did not complete the study for
personal reasons or protocol violations. An overview of our results with exact P-values can be
viewed in Table II.
Skin density
In the tap water group, skin density increased
highly significantly from 47 2.4 at baseline to
54 1.9 after the 4-week drinking phase (Fig. 1).
In contrast, measurements in the mineral water
group revealed a significant decrease from
45 2.15 before to 39 2.49 at the end of our
study (Fig. 1).
Skin thickness
Skin thickness decreased in the tap water group at
a highly significant level (1122 26.66 at baseline vs. 1062 22.8 after the drinking period, see
Fig. 2). In the mineral water group overall, skin
Parameter
Skin density
Skin thickness
(P 0.003)
(P
(entire group: P 0.187)
(P
(subgroup of subjects, who had
previously drunken little: P 0.031)
(P > 0.05)
(P <
(P 0.005)
(P
(P > 0.05)
(P >
Skin surface pH
Finger circumference
Skin surface morphology
(SEr, SEsm, R2, and volume)
0.001)
0.001)
0.001)
0.038)
0.05)
134
S. Williams et al.
60
***
Day 0
Day 28
55
**
50
45
54
40
45
35
47
39
30
Mineral water
Tap water
6%
Mineral water
Tap water
4%
2%
Skin surface pH
While the skin surface pH remained unchanged in
the physiologically optimal range in the mineral
water group (P > 0.05; see Fig. 4 for details), pH
significantly decreased in the tap water group
(5.19 0.10 before vs. 4.79 0.08 after the
drinking phase; Fig. 4).
0.8 %
Finger circumference
0%
2%
4%
5.3 % ***
6%
thickness did not change at a statistically significant level (slight increase from 969 22.19 at
baseline to 977 24.19 after the drinking period,
Fig. 2). However, when separately analysing those
individuals from the mineral water group, who
had routinely drunken comparably little before
the start of the study (<2 L day)1), their skin
thickness
increased
statistically
significant
(P 0.031).
In the mineral water group the finger circumference measured on the base of the ring finger
decreased significantly from 6.34 0.09 to
6.16 0.10 cm, while measurements in the tap
water group revealed a significant increase from
6.74 0.10 to 6.81 0.08 cm (Fig. 5).
Discussion
Adequate fluid intake, in particular from non-alcoholic, non-caffeinated and non-caloric beverages
such as water has been shown to be beneficial
for various aspects of general health and to be
protective against diverse medical conditions
[27,913]. Despite the acknowledged physiological significance of water to life and the general
claim that the consumption of ample amounts of
water is somehow beneficial for skin, very little is
known about the objective in vivo influence of
135
S. Williams et al.
Skin surface pH
6.0
Day 0
Day 28
***
5.5
5.0
5.49
5.38
5.19
4.5
4.79
4.0
Mineral water
Tap water
Day 0
Day 28
7.5
7.0
**
6.5
6.0
5.5
5.0
6.74
6.34
6.81
6.16
4.5
Mineral water
Tap water
water intake on different aspects of skin physiology. With our study, we were able to demonstrate
that the consumption of more than 2 L of water
per day can indeed have a measurable influence
on skin physiology in healthy volunteers. Furthermore, the concrete effects seem to depend on the
exact nature of the ingested water. In detail, our
measurements revealed that mineral water causes
a significantly reduced finger circumference, a statistically significant decrease in sonographic skin
density and in those individuals, who had previously drunken comparably little a significantly
increased skin thickness. The observed changes
were higher in probands, who had previously
drunken comparably little. Pure tap water on the
other hand led to a significantly increased finger
circumference, significantly increased skin density
and significantly decreased skin thickness.
Not all of the objectively measured changes can
be explained straightforwardly, as the exact underlying mechanisms necessitate further research in
this area. However, the decrease in skin density
136
S. Williams et al.
study. We would also like to thank Heike Buntrock, Volker Braun, Sandra Schroder, Alexandra
Butehorn, Annette Schuler and Tatjana Schwill
for their dedication and diligence, which made the
successful execution and completion of this study
possible.
Part of this study was sponsored by Staatlich
Fachingen, Fachingen, Germany.
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